B. E-MAIL CONTACT AT FILER (optional)

FILING OFFICE COPY — UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11)

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY

UCC FINANCING STATEMENTFOLLOW INSTRUCTIONS

A. NAME & PHONE OF CONTACT AT FILER (optional)

OR

1a. ORGANIZATION'S NAME

POSTAL CODECITY1c. MAILING ADDRESS

1b. INDIVIDUAL'S SURNAME

STATE COUNTRY

8. OPTIONAL FILER REFERENCE DATA:

A Debtor is a Transmitting UtilityManufactured-Home TransactionPublic-Finance Transaction

6a. Check only if applicable and check only one box:

7. ALTERNATIVE DESIGNATION (if applicable): Seller/Buyer Bailee/BailorConsignee/ConsignorLessee/Lessor

Agricultural Lien Non-UCC Filing

OR 3b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME

POSTAL CODE3c. MAILING ADDRESS CITY

ADDITIONAL NAME(S)/INITIAL(S)

STATE

SUFFIX

COUNTRY

3a. ORGANIZATION'S NAME3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only one Secured Party name (3a or 3b)

4. COLLATERAL: This financing statement covers the following collateral:

C. SEND ACKNOWLEDGMENT TO: (Name and Address)

6b. Check only if applicable and check only one box:

Licensee/Licensor

Collateral is5. Check only if applicable and check only one box: held in a Trust (see UCC1Ad, item 17 and Instructions) being administered by a Decedent’s Personal Representative

OR

2a. ORGANIZATION'S NAME

POSTAL CODECITY2c. MAILING ADDRESS

2b. INDIVIDUAL'S SURNAME

STATE

SUFFIX

COUNTRY

FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

ADDITIONAL NAME(S)/INITIAL(S)FIRST PERSONAL NAME

1. DEBTOR'S NAME: Provide only one Debtor name (1a or 1b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor’s name); if any part of the Individual Debtor’sname will not fit in line 1b, leave all of item 1 blank, check here and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)

2. DEBTOR'S NAME: Provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor’s name); if any part of the Individual Debtor’sname will not fit in line 2b, leave all of item 2 blank, check here and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)

UNITED STATES Department of Labor:

STATE OF _________________ Department of Labor:

STATE OF _________________ Department of Labor:

Security Labor Credit Payments and Account Liquidation Window.

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Security Labor Credit Wager Payments and Labor Account Liquidation Window.

Security Labor Credit Wager Payments and Labor Account Liquidation Window.

BAILOR/BAILEE NON-UCC # US LABOR WAGERING CREDIT Attachment Sheet # 1

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